Postoperative wound monitoring app shows potential to reduce readmissions

By Jeff Lagasse

Sending images of surgical wounds to hospital nurses could be an effective way to detect surgical site infections, thereby reducing readmissions, new research shows. And a new smartphone app aims to make that happen.

Dubbed WoundCare, the app was developed by researchers from the Wisconsin Institute of Surgical Outcomes Research, Department of Surgery, University of Wisconsin, Madison, with the goal of earlier detection of surgical site infections and prevention of hospital readmissions.

Surgical site infections, or SSIs, are the most common hospital-acquired infection and the leading cause of hospital readmission following an operation. And readmissions are a big reason why many hospitals, which fall short of certain readmissions-related benchmarks, are financially penalized by the federal government.

Due to the prevalence off SSIs, the WiSOR research team decided to see if postoperative wound monitoring could be effectively achieved by having patients upload photos through the WoundCare app and answer a few brief questions to gather information not easily captured through images.

"Patients cannot identify [infections] and frequently ignore or fail to recognize the early signs of cellulitis or other wound complications," the study's authors wrote. "This drawback leads to the common and frustrating scenario where patients present to a routine, scheduled clinic appointment with an advanced wound complication that requires readmission, with or without reoperation. However, the complication may have been amenable to outpatient management if detected earlier." 

Forty vascular surgery patients were enrolled in the study. There was an overall data submission rate of 90.2 percent among participants, and submissions were reviewed within an average of 9.7 hours. During the study, seven wound complications were detected and one false negative was found.

Patients were enthusiastic about the app's ease of use and the reassurance they felt having their wounds regularly monitored. The nurse practitioners responsible for reviewing the submitted images attested to the value of the photos and patient satisfaction, although they also noted it was difficult to find time to review the submitted images on top of an already heavy clinical workload. 

The authors said the success and sustainability of a post-discharge wound-monitoring protocol requires a dedicated transitional care program, and not simply adding a task to the current staff workload.

The protocol also has a cost-savings component beyond avoiding readmissions penalties. SSIs, according to the research, is the most expensive hospital-acquired infection, costing an average of nearly $30,000 per wound-related readmission and an estimated $3-10 billion annually.